Lifestyle and environmental factors have long been recognized as important contributors to the onset and progression of multiple sclerosis (MS). While this connection is well studied in adults, its role in pediatric MS, where prevention and disease modification may have lifelong implications, is still emerging. Understanding how modifiable factors such as vitamin D levels, obesity, diet, and physical activity influence disease trajectory is increasingly vital for clinicians treating children with MS, particularly as the field moves toward more comprehensive and multidisciplinary models of care.
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NeurologyLive: Summarize your CNS presentation, what were the greatest takeaways?
James Nicholas Brenton, MD: I spent a lot of time talking about the environmental impacts on MS disease course—not just the risk, but how those factors affect progression over time. We discussed vitamin D deficiency, obesity, smoking, physical activity, and diet. There are many known risk factors for developing MS in kids, but by the time we meet these patients, those risks have already occurred. What really interests me are the factors we can still modify or manipulate after diagnosis—those that might influence disease outcomes going forward.
Let’s start with vitamin D. How strong is the evidence for supplementation in pediatric MS, and how do you approach this clinically?
Vitamin D is clearly important, but there’s still debate about how much benefit supplementation provides when added to disease-modifying therapy. Several clinical trials have produced mixed findings—some show improvement in MRI outcomes, while others show little to no difference. My takeaway is that supplementation is a benign and reasonable intervention. I recommend it for my patients because it’s low-risk, and there’s potential for benefit, even if the precise magnitude of that benefit remains uncertain.
Beyond vitamin D, you touched on obesity and dietary factors. What do we know about their impact on MS in children?
This is an area of growing interest. Recent evidence suggests that obesity in patients with MS may worsen disease outcomes—including disability progression, MRI activity, quality of life, and even cognition. These findings are pushing us to think more critically about how to intervene. Can weight management or dietary changes actually slow disease trajectories? We don’t yet have all the answers, but it’s becoming clear that these lifestyle factors are not secondary—they’re central to long-term health.
What can healthcare providers do to address issues like obesity in pediatric MS care?
It’s tricky, because as pediatric neuroimmunologists, our clinic time is already packed with counseling on disease-modifying therapies, monitoring, and symptom management. Still, comprehensive care means acknowledging all these other factors. The best way to make this practical is through a team approach.
That might mean looping in a primary care provider, a dietitian, or a nutritionist who can reinforce healthy habits between neurology visits. Some centers have access to multidisciplinary clinics or healthy weight programs, and those can be extremely valuable. The goal is to build systems that address diet, physical activity, and healthy weight without it all falling solely on the neurologist.
What role can pediatricians play in supporting patients with MS, particularly given how rare pediatric-onset disease can be?
Communication between specialists and primary care physicians is absolutely essential. Pediatric MS isn’t something most pediatricians encounter often, so neurologists should take the initiative to reach out, share information, and establish an ongoing dialogue. I always encourage pediatricians to contact me directly with any questions—they know the patient and family best, and their involvement is critical.
Many aspects of MS care, such as promoting a healthy diet or physical activity, fall squarely within the pediatrician’s expertise. When we work together, we can target both MS-specific goals and overall health, ultimately improving quality of life for these children. This partnership approach is really the future of comprehensive pediatric MS care.